4.6 Article

Comparison of Clinical and Radiologic Findings Between Perforated and Non-Perforated Choledochal Cysts in Children

期刊

KOREAN JOURNAL OF RADIOLOGY
卷 23, 期 2, 页码 271-279

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KOREAN SOCIETY OF RADIOLOGY
DOI: 10.3348/kjr.2021.0169

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Choledochal cyst; Spontaneous perforation; Child; Hepatobiliary imaging

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This study compared the clinical and radiologic findings between perforated and non-perforated choledochal cysts. The results showed that children with perforated choledochal cysts had more severe symptoms, higher levels of inflammatory markers, and a higher incidence of ascites compared to those with non-perforated cysts.
Objective: To compare the clinical and radiologic findings between perforated and non-perforated choledochal cysts in Materials and Methods: Fourteen patients (mean age +/- standard deviation, 1.7 +/- 1.2 years) with perforated choledochal cysts (perforated group) and 204 patients (3.6 +/- 3.8 years) with non-perforated choledochal cysts (non-perforated group) were included between 2000 and 2019. All patients underwent choledochal cyst excision after ultrasound, CT, or MR and outcomes were analyzed. Statistical differences were compared using the Mann-Whitney U test and Fisher's exact test. Results: Choledochal cyst perforation occurred only in children under the age of 4 years. Acute symptoms, including fever (p < 0.001), were more common in the perforated group than in the non-perforated group. High levels of white blood cells (p = 0.004), C-reactive protein (p < 0.001), and serum amylase (p = 0.002), and low levels of albumin (p < 0.001) were significantly associated with the perforated group. All 14 patients with perforated choledochal cysts had ascites, whereas only 16% (33/204) of patients in the non-perforated group had ascites (p < 0.001). In the subgroup of patients who had ascites, a large amount of ascites (p = 0.001), increase in the amount of ascites in a short time (p < 0.001), complex ascites (p < 0.001), and perihepatic pseudocysts (p < 0.001) were more common in the perforated group than in the non-perforated Conclusion: Children with perforated choledochal cysts have characteristic clinical and radiologic findings compared to those with non-perforated choledochal cysts. In young children with choledochal cysts, perforation should be differentiated in cases with acute symptoms, laboratory abnormalities, and characteristic ascites findings.

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